Healthcare Provider Details

I. General information

NPI: 1205313491
Provider Name (Legal Business Name): CIARA T DIXON MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 WESSEX CT
WENTZVILLE MO
63385-4398
US

IV. Provider business mailing address

71 WESSEX CT
WENTZVILLE MO
63385-4398
US

V. Phone/Fax

Practice location:
  • Phone: 314-649-7491
  • Fax: 855-674-1812
Mailing address:
  • Phone: 314-649-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2018025908
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2018025908
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018025908
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: